Provider Demographics
NPI:1326164419
Name:POWERS, DONALD P (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MARLIN WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4328
Mailing Address - Country:US
Mailing Address - Phone:949-824-5812
Mailing Address - Fax:949-824-1378
Practice Address - Street 1:STUDENT HEALTH CTR
Practice Address - Street 2:501 STUDENT HEALTH
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-5200
Practice Address - Country:US
Practice Address - Phone:949-824-5812
Practice Address - Fax:949-824-1378
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA19182OtherMD LICENSE